NUR 326 PHARMACOLOGY AND PATHOPHYSIOLOGY II QUESTIONS WELL ANSWERED LATEST UPDATE 2026

NUR 326 PHARMACOLOGY AND PATHOPHYSIOLOGY II QUESTIONS WELL ANSWERED LATEST UPDATE 2026 Non- modifiable osteoporosis risk factors - Answers Age 30 Female (esp after menopause) Family hx Hx of bone trauma Modifiable osteoporosis risk factors - Answers Low BMI/ small frame Low estrogen/androgen Active/passive smoking Alc intake Prolonged immobility/lack of exercise Excessive caffeine Low Ca +Vit D diet Myasthenia gravis assessment findings - Answers Weakness more prominent as day goes on Face: ptosis, masklike expression, extraocular movement Throat/neck: frequent gagging/choking when eating, slurred speech/hoarse Arms/legs: weak Severe cases: SOB Alzheimer's pathophysiology - Answers Buildup of plaque and tangles of fibrous tissue that impairs ability of impulses to be transferred between neurons Cortex shrivels- affect thinking, planning, memory Ventricles fill with fluid and grow Hippocampus shrinks Vascular dementia pathophysiology - Answers Decreased blood flow to specific lobe of brain More predictable deficits than other types of dementia Common following stroke, seizures Dementia assessment findings - Answers Chronic confused state Most common 65 yo Affect ability to learn new info Memory loss Poor self care Under/overweight Short fuse/agitation Sundowning: confusion increases, personality changes at/around sunset Seizure pathophysiology - Answers Sudden, abnormal, excessive, uncontrolled discharge of neurons within the brain that may result in change in LOC, motor or sensory ability, or bahavior Epilepsy - Answers 2+ seizures unprovoked by seizure activity Primary (idiopathic) epilepsy - Answers Seizures not associated with any identifiable brain lesion Secondary epilepsy - Answers Seizures associated with underlying brain lesion. metabolic disorders, alcohol withdrawal/substance abuse, electrolyte imbalance, stroke/head trauma, or heart disease Urate - Answers Byproduct of purine metabolism Buildup of uric acid Formation of uric acid - Answers Purine metabolism- hypoxanthine- xanthine- uric acid Osteoporosis - Answers Chronic disease that causes significant decrease in bone density Osteopenia - Answers Bone loss not to extent of osteoporosis Osteoblast/clast activity over lifetime - Answers Osteoblast activity decreases to be lower than osteoclast activity at 30 yo Menopause affect on osteoblast activity - Answers Decrease in estrogen leads to decrease in osteoblast activity- bone loss Foods high in tyramine - Answers Avocadoes, soybeans, figs, smoked meats, cheese, yeast, chocolate, caffeine Osteoporosis meds - Answers Calcium w/ vit D, Calcitonin, SERMs, Biphosphonates CVA pathophysiology - Answers Interruption of perfusion to any part of brain Types of CVA - Answers Ischemic: sudden blockage of cerebral blood vessel Hemorrhagic: bleeding Ateriovenous malformation Generalized seizure - Answers Both hemispheres involved Tonic seizure - Answers Generalized seizure Sudden muscle rigidity, loss of consciousness, autonomic change 30 seconds to several minutes Clonic seizure - Answers Generalized seizure Rhythmic jerking of body parts Several minutes Tonic-clonic seizure - Answers Generalized seizure Tonic then clonic 1-3 minutes Myoclonic seizure - Answers Generalized seizure Brief jerking or rigidity Few seconds Atonic seizure - Answers Generalized seizure Sudden loss of muscle tone Few seconds Absence seizure - Answers Generalized seizure Blank stare for 20 sec, no memory of event Myasthenia gravis diagnostic testing - Answers Tensilon test Tensilon test - Answers Rapid acting anticholinesterase drug (edrophonium) is administered If strength is improved, MG is diagnosed Dementia treatment to slow progression - Answers Cholinesterase inhibitors N-methyl-d-aspartase receptor antagonist Dementia treatment for symptom management - Answers Antidepressants Antianxiety Parkinson's disease treatment - Answers *Treatment of symptoms only Dopamine replacement drugs Monoamine Oxidase-B inhibitors Central muscarinic antagonists (AntiACh) Memantine drug class - Answers N-Methyl-D-Aspartate (NMDA) Receptor Antagonist Memantine indication - Answers Dementia Memantine MOA - Answers Regulate Ca in neurons to make neural impulse signals more prominent Memantine SE - Answers Increase confusion Memantine admin - Answers Tapered up to therapeutic effect Benzotropine med class - Answers Central muscarinic antagonist (AntiACh) Benzotropine indication - Answers Parkinson's disease and Parkinsonism Benzotropine MOA - Answers Block ACh from binding to receptor in brain to allow dopamine levels to balance Benzotropine SE - Answers ABCDS Benzotropine contraindications - Answers Other AntiACh meds, ACh meds Levodopa/cabidopa med class - Answers Dopamine replacement/dopamine agonist Levodopa/cabidopa indications - Answers Parkinson's disease Levodopa/cabidopa SE - Answers N/V Dyskinesia Psychosis/depression/suicidal thoughts Levodopa/cabidopa MOA - Answers Levodopa: precursor to dopamine- mimics and promote dopamine Carbidopa: prevent metabolism of levodopa before it crosses BBB Levodopa/cabidopa admin - Answers 30-60 min before fine motor movements/sleep Take with food for GI upset Levodopa/cabidopa resistance - Answers May develop resistance and require a drug holiday to return to therapeutic capabilities Aledronate med class - Answers Biphosphonates Aledronate MOA - Answers Inhibit osteoclast activity Aledronate SE - Answers Esophageal irritation Arthralgia (joint pain) Myalgia (muscle pain) Aledronate admin - Answers 1x/week Morning med on empty stomach 30 min before other meds and food Swallowed whole with full glass of WATER Sit with hips at 90 degrees or stand for 30 min after admin Raloxifene med class - Answers Selective Estrogen Reuptake Modulators Raloxifene MOA - Answers Decrease osteoclast activity Aledronate indication - Answers Osteoporosis Raloxifene SE - Answers Blackbox: risk of VTE Hot flashes Leg cramps Raloxifene indications - Answers Osteoporosis Raloxifene contraindications - Answers Hx/increased risk of VTE Pregnancy Prolonged immobilization SERMs before flights - Answers May be advised to stop SERMs pre flight to decrease risk of VTE Advised to stand/mobilize q 30 min during flight Neostigmine med class - Answers Acetylcholinesterase inhibitor Neostigmine indication - Answers Myasthenia gravis Neostigmine MOA - Answers Block enzyme that breaks down ACh at neuromuscular junction Neostigmine SE - Answers Bradycardia/risk for sycope Heighted GI symptoms Muscle cramps/spasms Cholinergic crisis Cholinergic crisis antidote - Answers Atropine Neostigmine contraindications - Answers Anti ACh meds Pyridostigmine med class - Answers Acetylcholinesterase inhibitor Pyridostigmine MOA - Answers Block enzyme that breaks down ACh at neuromuscular junction Pyridostigmine indication - Answers Myasthenia gravis Pyridostigmine SE - Answers Bradycardia/risk for sycope Heighted GI symptoms Muscle cramps/spasms Cholinergic crisis Pyridostigmine contraindications - Answers Anti ACh meds tPA (alteplase) med class - Answers Fibrinolytic/thrombolytic tPA (alteplase) MOA - Answers clot breaking, imitate factor 13 tPA (alteplase) SE - Answers Bleeding tPA (alteplase) indication - Answers Ischemic stroke tPA (alteplase) contraindications - Answers Acute/hx of hemorrhagic stroke Stroke affecting more than 1/3 of brain Anticoagulant admin in last 48 hr Active bleeding Head trauma/ recent intercranial surgery Spinal surgery within last 3 mo BG less than 50 INR greater than 1.7 Platelets less than 100 aPTT greater than 40 tPA (alteplase) admin - Answers IV Weight based Loading dose Phenobarbital med class - Answers Barbiturates Phenobarbital indication - Answers Prevent seizures Phenobarbital MOA - Answers Potentiate GABA Phenobarbital SE - Answers Sedation Teratogenic Long term- Vit D and K deficiencies (risk for bleeding) Phenobarbital considerations - Answers Risk for abuse Phenobarbital labs - Answers Therapeutic levels INR for vit K deficiency Phenobarbital contraindications - Answers Pregnancy Other CNS depressants Phenobarbital admin - Answers Same time daily Do not stop abruptly Levetiracetam med class - Answers Phenytoin-related drugs Levetiracetam indication - Answers Prevent seizures Levetiracetam MOA - Answers Inhibit influx of sodium into neurons Levetiracetam SE - Answers Neuropsych- agitation, suicidal thoughts Drowsy Teratogenic Levetiracetam labs - Answers Therapeutic levels Levetiracetam admin - Answers Same time daily Do not stop abruptly Levetiracetam contraindications - Answers Pregnancy Other CNS depressants Phenytoin med class - Answers Hydantoins Phenytoin indications - Answers Prevent seizures Phenytoin MOA - Answers Inhibit influx of sodium into neurons Phenytoin SE - Answers Gingival hyperplasia Drowsiness Teratogenic Phenytoin labs - Answers Therapeutic levels Phenytoin admin - Answers Same time daily Do not stop abruptly Phenytoin contraindications - Answers Pregnancy Other CNS depressants Poor oral hygiene practices Diazepam med class - Answers Benzodiazepines Diazepam indication - Answers Status epilepticus (prolonged seizure) Anxiety Diazepam MOA - Answers Potentiate GABA Diazepam SE - Answers Drowsy Lethargy Respiratory depression Bradycardia Hypotension Teratogenic Diazepam admin - Answers Rectal IV IM Nasal Diazepam contraindications - Answers Pregnancy Flumazenil - Answers Antidote for respiratory depression/bradycardia related to benzodiazepines Lorazepam med class - Answers Benzodiazepines Lorazepam indications - Answers Status epilepticus (prolonged seizure) Anxiety Lorazepam MOA - Answers Potentiate GABA Lorazepam SE - Answers Drowsy Lethargy Respiratory depression Bradycardia Hypotension Teratogenic Lorazepam contraindications - Answers Pregnancy Lorazepam admin - Answers IV (preferred Buccal Sublingual Nasal IM Allopurinol med class - Answers Anti-gout Allopurinol indications - Answers Prevent gout Allopurinol MOA - Answers Stop formation of xanthine (precursor to uric acid) Allopurinol SE - Answers Acute kidney injury Allopurinol labs and monitoring - Answers Creatinine GFR I&O Uric acid levels Allopurinol admin - Answers Daily med Selegiline med class - Answers Monoamine Oxidase B inhibitors Selegiline MOA - Answers Inhibit MAOB in brain and body- less dopamine reuptake- more dopamine availabe Selegiline indications - Answers Parkinson's disease Selegiline SE - Answers Insomnia HTN crisis when combined with tyramine Selegiline admin - Answers Morning/before noon Selegiline contraindications - Answers Tyramine foods Meds that increase BP Other MAOB meds Poor sleep hygiene Colchicine med class - Answers Anti-gout Colchicine MOA - Answers Reduce inflammatory response to uric acid deposits by inhibiting cell mitosis Colchicine indication - Answers Acute gout attacks Colchicine SE - Answers Blood dyscrasias- anemia, thrombocytopenia, leukopenia Colchicine admin - Answers Short term only *does not address pain immediately Colchicine contraindications - Answers Pregnancy Grapefruit Valproic acid med class - Answers Valproate Valproic acid indication - Answers Prevent seizure Valproic acid MOA - Answers Inhibit influx of sodium, increase GABA Valproic acid SE - Answers Hepatotoxic GI related Drowsy Teratogenic Valproic acid labs - Answers LFTs Therapeutic levels Valproic acid admin - Answers Same time daily Do not stop abruptly Valproic acid contraindications - Answers Pregnancy Other CNS depressants Donepezil med class - Answers Cholinesterase inhibitor Donepezil MOA - Answers Brain focused Stop enzyme from breaking down ACh= more ACh Donepezil indication - Answers Dementia Donepezil SE - Answers Bradycardia N/V/D Dyspepsia Donepezil admin - Answers At bedtime Donepezil contraindications - Answers NSAIDs Alcohol Anti ACh meds Rivastigmine med class - Answers Cholinesterase inhibitor Rivastigmine indication - Answers Dementia Rivastigmine MOA - Answers Brain focused Stop enzyme from breaking down ACh= more ACh Rivastigmine SE - Answers Bradycardia N/V/D Dyspepsia Rivastigmine admin - Answers At bedtime Rivastigmine contraindications - Answers NSAIDs Alcohol Anti ACh meds Gout pathophysiology - Answers Form of arthritis Systemic disease in which urate crystals deposit in joints CVA lab testing to r/o other causes of neuro changes - Answers Blood glucose WBC Electrolytes CVA lab testing to determine if tPA admin is safe - Answers Platelets PT/INR aPTT/PTT Right hemisphere CVA residual effects - Answers Paralyzed left side Spatial perceptual deficits Tend to minimize problems Short attention span Visual field deficits Impaired judgement Impulsive Impaired time concept Left hemisphere CVA residual effects - Answers Paralyzed right side Impaired speech and language Slow performance Visual field deficits Aware of deficits Impaired comprehension Myasthenia gravis pathophysiology - Answers Autoimmune progressive neurological condition Immune system attacks muscle receptors that control voluntary muscles Communication between muscle and neurons inhibited Thymus= overproduction of antibodies and often enlarged Anti ACh effects - Answers Fight/Flight ABCDS- Altered mental status, Blurred vision, Confusion/Constipation, Dry mouth/eyes, Stasis of urine/sweat Cholinergic effects - Answers Rest and digest DUMBELS- Diarrhea, Urination, Miosis, Bradycardia/Bronchorrhea, Emesis, Lacrimation, Salivation Myasthenia crisis - Answers Extreme weakness and fatigue Increased strength with edrophonium Cholinergic crisis - Answers Extreme weakness and fatigue Bradycardia Excessive drooling Decrease strength wit edrophonium Parkinson's disease pathophysiology - Answers Degeneration- decrease in dopamine- muscle and voluntary movements less refined- debilitating mobility Parkinsonism pathophysiology - Answers Symptoms mirror Parkinson's disease caused by other factors including meds, toxins, strokes, tumors etc TIA pathophysiology - Answers Brief interruption in cerebral blood flow Considered precursor to stroke TIA assessment findings - Answers S/S improve in 30-60 min, resolve in 24 hr Blurred vision Diplopia Blindness in one eye Tunnel vision Weakness Ataxia Numbess Vertigo Aphasia Dysarthia TIA treatment - Answers Stroke prevention Ischemia CVA clinical manifestations - Answers ABRUPT onset of symptoms Sudden confusion or trouble speaking/understanding others Sudden numbness/weakness in face, arm, leg Sudden trouble seeing in one or both eyes Sudden dizziness, trouble walking, or loss of balance or coordination Sudden headache with no known cause Parkinson's disease diagnostics - Answers Subjective with physical assessment-weakness, low movement, tremors MRI may be used to r/o other CNS causes Parkinson's disease labs - Answers CSF may show decrease in dopamine *spinal tap (not routinely done) Analgesics for gout - Answers NSAIDs to decrease pain and swelling Osteoporosis assessment findings - Answers S/S of fractures Dowager's hump (kyphosis) Loss in height (2-3 inches in 20 years) Back pain/pain in bones Common fracture locations - Answers Distal ends of radius and proximal femur Seizure lab testing - Answers Used to identify causes of secondary seizures Electrolytes Blood glucose Tox screen Inflammation labs - Answers Erythrocyte sediment rate C-reactive protein Erythrocyte sediment rate (ESR) - Answers Long term inflammation marker mm (distance) per hr that RBCs sink Inflammation- RBC stick together- sink faster in test tube C-reactive protein (CRP) - Answers Short term inflammation marker Elevates within hours of inflammation Protein released by liver when there is swelling Parkinson's disease assessment findings - Answers Reports of freezing Shuffling gait Cogwheel rigidity (jerky resistance to ROM) Leadpipe rigidity (constant resistant to ROM) Fatigue Masklike face Constipation/incontinence Postural instability Progression of Parkinson's disease - Answers Early: tremors start (upper extremities first, unilateral progressing to bilateral) Middle: tremors advance, muscle rigidity, bradykinesia Late: akinesia Gout labs - Answers Uric acid levels ESR CRP S/S of hypertensive crisis - Answers Headache Blurred vision Nosebleeds SBP 180, DBP120 Blood dyscrasias s/s - Answers Anemia: fatigue, short of breath on stairs Thrombocytopenia: bleeding, bruising, petechiae Leukopenia: s/s of infection Ischemic CVA risk factors - Answers Genetics